Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: a randomized clinical trial

Objective

Behavioral activation (BA) is an effective treatment for depression. We investigated the effectiveness of add-on group-format BA and peer support (PS) with treatment as usual (TAU) in a registered randomized clinical trial in psychiatric outpatient settings (ISRCTN10647845).

Methods

Adult outpatients (N = 140) with major depressive disorder (MDD) and Patient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) group BA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS, including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. The primary outcome was a within-individual change in PHQ-9 score between baseline and 8 weeks. Secondary outcomes were 1) response, 2) remission, and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months.

Results

Of the randomized patients, 100 (71.4%) completed treatments, including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PS group, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scores declined most in the TAU group [BA -0.28 (95% CI -2.48, 1.92), PS -0.58 (-2.09, 0.94) vs. TAU -3.32 (-5.21, -1.44); group-difference test, p = 0.034]. The secondary outcomes in the BA or PS arms did not significantly differ from those in TAU. Videotaped sessions revealed marked variation in briefly trained therapists' adherence to the treatment manual.

Conclusions

In this randomized trial, the effectiveness of treatments with the added BA and PS groups did not exceed that of TAU alone. The preconditions in which brief BA or PS group interventions benefit outpatients with depression in psychiatric settings warrant critical investigation.

Mental health service diversity and work disability: associations of mental health service system characteristics and mood disorder disability pensioning in Finland

PURPOSE

Public mental health services (MHS) are crucial in preventing psychiatric disability pensions (DP). We studied the associations between mood disorder DP risk and the characteristics of Finnish municipalities' MHS provision using the ESMS-R mapping tool and Finnish population registers, based on first-time granted mood disorder DPs between 2010 and 2015.

METHODS

The final data set included 13,783 first-time mood disorder DP recipients and 1088 mental health service units in 104 municipalities. We focused on five different MHS types: all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. Three factors for each MHS type were studied: service resources, richness, and diversity index. Negative binomial regression models were used in the analysis.

RESULTS

In all the municipalities, higher service richness and diversity regarding all MHS, outpatient care and local services with gatekeeping were associated with a lower DP risk. In urban municipalities, service richness was mainly associated with lower DP risk, and in semi-urban municipalities service diversity and resources were primarily associated with lower DP risk in outpatient care and local services with gatekeeping. In rural municipalities, DP risk indicated no association with MHS factors.

CONCLUSION

The organization and structure of MHS play a role in psychiatric disability pensioning. MHS richness and diversity are associated with lower mood disorder DP in specific societal contexts indicating their role as quality indicators for regional MHS. The diversity of service provision should be accounted for in MHS planning to offer services matching population needs.

Patterns of mental health services and mood disorder disability pensions: a standard comparison of Finland's three largest hospital districts

INTRODUCTION

Mental disorders are one of the most common and disabling health conditions worldwide. There is however no consensus on the best practice of system level mental health services (MHS) provision, in order to prevent e.g. mood disorder disability pensions (DPs). We analyzed the MHS provision between Finland's three largest hospital districts Helsinki and Uusimaa (HUS), Southwest Finland and Pirkanmaa, with known differences in mood disorder DP risk but presumably equal rates of mood disorder prevalence.

METHODS

We used public MHS data analyzed with the standardized DEscription and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) mapping tool, focusing on all MHS, outpatient care provision, local services without and with gatekeeping, and centralized services. We also collected demographic data based on the European Socio-Demographic Schedule (ESDS). As a novel approach, the Gini-Simpson Diversity Index (GSDI) was calculated for the districts.

RESULTS

Evident differences were observed regarding the districts' MHS factors. As the hospital district with lower DP risk, HUS was characterized by the highest level of regional socioeconomic prosperity as well as high service richness and diversity. With a nationally average DP risk, Southwest Finland had the highest number of MHS personnel in full-time equivalents (FTE) per 100 000 inhabitants. Pirkanmaa, with a higher DP risk, had overall the lowest service richness and the lowest FTE of the three districts in all MHS, outpatient care and local services with gatekeeping.

CONCLUSIONS

Our findings indicate that greater richness and diversity of MHS, especially in outpatient and community-based settings, may serve as indicators of a balanced, high-quality service system that is more effective in preventing mood disorder DP and meeting the different needs of the population. In addition, the need for sufficient resourcing in all MHS and outpatient services is indicated. We suggest using diversity indices to complement the measuring and reporting of regional service variation.

Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE

To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed.

MATERIALS AND METHODS

Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test.

RESULTS

OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function.

CONCLUSIONS

Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.

Contextual and mental health service factors in mental disorder-based disability pensioning in Finland - a regional comparison

Background

We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP.

Methods

Subjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model.

Results

Significant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06–1.14) and mood disorder (IRR 1.12; 95% CI 1.08–1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP.

Conclusions

In this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07099-4.

Definition and Characteristics of Behavioral Medicine, and Main Tasks and Goals of the International Society of Behavioral Medicine-an International Delphi Study

BACKGROUND

In the past decades, behavioral medicine has attained global recognition. Due to its global reach, a critical need has emerged to consider whether the original definition of behavioral medicine is still valid, comprehensive, and inclusive, and to reconsider the main tasks and goals of the International Society of Behavioral Medicine (ISBM), as the umbrella organization in the field. The purpose of the present study was to (i) update the definition and scope of behavioral medicine and its defining characteristics; and (ii) develop a proposal on ISBM's main tasks and goals.

METHOD

Our study used the Delphi method. A core group prepared a discussion paper. An international Delphi panel rated questions and provided comments. The panel intended to reach an a priori defined level of consensus (i.e., 70%).

RESULTS

The international panel reached consensus on an updated definition and scope of behavioral medicine as a field of research and practice that builds on collaboration among multiple disciplines. These disciplines are concerned with development and application of behavioral and biomedical evidence across the disease continuum in clinical and public health domains. Consensus was reached on a proposal for ISBM's main tasks and goals focused on supporting communication and collaboration across disciplines and participating organizations; stimulating research, education, and practice; and supporting individuals and organizations in the field.

CONCLUSION

The consensus on definition and scope of behavioral medicine and ISBM's tasks and goals provides a foundational step toward achieving these goals.

Motivational Interviewing and Glycemic Control in Adolescents With Poorly Controlled Type 1 Diabetes: A Randomized Controlled Pilot Trial

A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI's short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.

Screening social phobia in adolescents from general population: The validity of the Social Phobia Inventory (SPIN) against a clinical interview

Social phobia (SP) has onset during early adolescence, and is associated with significant impairment in social and educational functioning of adolescents. Therefore, valid and easy-to-use tools for screening and identification of SP among adolescent community populations are needed. We investigated both construct and discriminative validity, and screening properties of the 17-item Social Phobia Inventory (SPIN) relative to SP diagnoses based on a semi-structured clinical interview (K-SADS-PL), in a sample of 752 12 to 17-year-old Finnish students from general population. The SPIN demonstrated good properties to differentiate adolescents with SP and those with sub-clinical SP symptoms (SSP), from adolescents without SP. The SPIN also differentiated adolescents with SP from those with depressive and disruptive disorders. In this sample 27% of participants scored above the previously suggested SPIN cut-off (15 points) for adolescent SP. We suggest using a somewhat higher cut-off score, 24 points, when using the SPIN as a screen for SP in general adolescent populations. This cut-off score resulted in a sensitivity of 81.2%, a specificity of 85.1%, a positive predictive value of 26.9%, and a negative predictive value of 98.6% in relation to the SP diagnosis in our sample. To screen for both SP and SSP, 19 points as a cut-off score produced satisfactory diagnostic efficiency statistics. The SPIN appears to have good properties for screening and identification of adolescent SP.

Beyond PTSD and Fear-Based Conditioning: Anger-Related Responses Following Experiences of Forced Migration-A Systematic Review

Introduction: Experiences of forced migration include traumas that are interpersonal in nature, as well as ongoing emotional responses, stress, and frustration in post-migration setti ngs. Open questions exist, regarding anger/anger-like responses following experiences of persecution and ongoing stress. The aim of this study was to explore the adaptive and maladaptive underlying mechanisms of anger/anger-like responses, cultural, linguistic, and social contingencies, and possible interventions for problematic anger behavior. Method: We searched two databases (PsycINFO and PILOTS) with the following search terms: (refugee OR "asylum seek*" OR IDP OR "internal* displac*" OR "forced migra*" OR "involuntary migra*") AND anger. Findings: This search yielded 34 studies that were included in the final review. Although, anger is a moral, adaptive, and prosocial response, dysfunctional anger/anger-like responses arise from PTSD, "moral injury," complicated grief, and independent forms of anger behavior. Cultural, linguistic, and social issues also emerged from the search. Finally, considerations for treatment and intervention are discussed. Discussion: Anger responses following experiences of forced migration may require assessment beyond PTSD models currently framed by DSM and ICD. A very promising framework is the Adaptation and Development after Persecution and Trauma (ADAPT) model. Implications: Further longitudinal and epidemiological research will be necessary to continue testing the ADAPT model and to begin the process of assessing its cross-cultural coherence in other refugee populations (e.g., see Hinton et al., 2003). As anger behavior is also a societal issue, avenues for reconciliation, expression of grievances, employment, civic participation, and integration are needed.

Psychosocial well-being of prospective orthognathic-surgical patients

OBJECTIVE

To compare the psychosocial well-being of prospective orthognathic-surgical patients and controls.

MATERIALS AND METHODS

Sixty patients referred for assessment of orthognathic-surgical treatment need and 29 controls participated. All participants filled in the modified version of Secord and Jourard's Body Image Questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem scale, the Acceptance and Action Questionnaire II and a structured diary developed by the authors. Patients also filled in the Symptom Checklist 90. Patients assessed their dental appearance on a visual analogue scale modified from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Professional assessment was made from study models with the AC.

RESULTS

Patients rating their dental appearance as AC grades 5-10 suffered from lower orthognathic quality-of-life and poorer body image than the controls, while those with AC grades of 1-4 only had poorer oral function. Self-perceived dental appearance was more important to orthognathic quality-of-life and body image than an orthodontist's assessment. Patients and controls had equal psychological flexibility and self-esteem. In all, 23-57% of patients had significant psychiatric symptoms, which explained the adverse emotions patients felt during the day. Fifteen per cent of the patients had been bullied.

CONCLUSIONS

Many orthognathic-surgical patients cope well with their dentofacial deformities, despite functional masticatory problems. It seems that a subjective view of dental appearance may be a key factor in finding patients with psychosocial problems. It should be a major issue when considering psychosocial support and other treatment options.

Psychosocial correlates of atrial natriuretic peptide: a marker of vascular health

BACKGROUND

Psychosocial factors have been associated with cardiovascular outcomes, but few studies have examined the association between psychosocial function and natriuretic peptides.

PURPOSE

The purpose of this study is to determine the predictive value of hostility, anger, and social support in relation to atrial natriuretic peptide (ANP), a marker of vascular health, among middle-aged men.

METHODS

One hundred twenty-one men (mean age = 39.8 years, SD = 4.1) underwent assessments of ANP and completed the Cook-Medley Hostility Scale, the Spielberger State-Trait Anger Scale, and the Interview Schedule for Social Interaction.

RESULTS

Higher levels of hostility (β = 0.22 [95 % CI 0.04, 0.40], P = 0.032) and trait anger (β = 0.18 [95 % CI 0.01, 0.37], P = 0.044) were associated with greater ANP levels. In contrast, higher perceived social support was also associated with lower ANP levels, (β = -0.19 [95 % CI -0.05, -0.41], P = 0.010).

CONCLUSIONS

Psychosocial factors, including hostility, anger, and social support, are associated with varying ANP levels among middle-aged men, independent of cardiovascular and behavioral risk factors.

Defining behavior-environment interactions: translating and developing an experimental and applied behavior-analytic vocabulary in and to the national language

Verbal behavior, as in the use of terms, is an important part of scientific activity in general and behavior analysis in particular. Many glossaries and dictionaries of behavior analysis have been published in English, but few in any other language. Here we review the area of behavior analytic terminology, its translations, and development in languages other than English. As an example, we use our own mother tongue, Finnish, which provides a suitable example of the process of translation and development of behavior analytic terminology, because it differs from Indo-European languages and entails specific advantages and challenges in the translation process. We have published three editions of a general dictionary of behavior analysis including 801 terms relevant to the experimental analysis of behavior and applied behavior analysis and one edition of a dictionary of applied and clinical behavior analysis containing 280 terms. Because this work has been important to us, we hope this review will encourage similar work by behavior analysts in other countries whose native language is not English. Behavior analysis as an advanced science deserves widespread international dissemination and proper translations are essential to that goal.

Patients' perceptions of orthognathic treatment, well-being, and psychological or psychiatric status: a systematic review

OBJECTIVE

To conduct a systematic review of studies concerning the psychosocial well-being of surgical-orthodontic patients.

MATERIAL AND METHODS

Articles published between 2001 and 2009 were searched using PubMed, Web of Science, and PsycInfo. Only articles written in English were included. Articles on methodological issues or on patients with clefts or syndromes or studies in which treatment had included surgically assisted maxillary expansion or intermaxillary fixation were excluded. The exclusion of articles was carried out in collaboration with two reviewers. To find new relevant articles, references from all the obtained review articles were hand-searched. Thirty-five articles fulfilled the selection criteria and were included in this review.

RESULTS

The main motives for seeking treatment were improvements in self-confidence, appearance, and oral function. Patients were not found to suffer from psychiatric problems. Treatment resulted in self-reported improvements in well-being, even though these improvements were not found with current assessment methods. Changes in well-being were most often registered using measures designed for evaluation of the impact of oral health on quality of life (e.g. the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile).

CONCLUSIONS

Surgical-orthodontic patients do not experience psychiatric problems related to their dentofacial disharmony in general. However, subgroups of patients may still experience problems, such as anxiety or depression, as many studies only report patients' mean problem scores and compare them to controls' scores or population norms. New assessment methods focusing on day-to-day changes in mood and well-being, as well as prospective studies with controls, are needed.

Predicting arterial stiffness with ambulatory blood pressure: an 11-year follow-up

No prospective data have been published on whether ambulatory blood pressure (BP) works better than casual measurements in predicting arterial stiffness. This study with 11-year follow-up was launched to evaluate the usefulness of ambulatory intra-arterial BP in predicting pulse wave velocity (PWV). Ninety-seven previously healthy men were recruited from a routine physical check-up at baseline. BP was measured with standard cuff and intra-arterial ambulatory methods. Sixty-seven subjects with no antihypertensive medication were enrolled for a visit after a follow-up of 11 years. Arterial stiffness was estimated with PWV derived with impedance cardiography. Ambulatory 24-h systolic blood pressure (SBP) (r = 0.30, P = 0.01), 24-h mean arterial pressure (r = 0.27, P = 0.03), 24-h pulse pressure (r = 0.27, P = 0.03) and daytime SBP (r = 0.26, P = 0.03) were the best BP variables in predicting future PWV. Casual BP values did not bear significant correlations with future PWV. In hierarchical regression analysis, the best predictive value for future PWV was achieved with the model including ambulatory 24-h SBP, smoking (number of cigarettes) and age (adjusted R(2) = 0.26). In conclusion, to our knowledge, this is the only prospective follow-up study to show that ambulatory BP is superior to casual BP measurement in predicting future PWV.

The relationship between cardiac reactivity in the laboratory and in real life

OBJECTIVE

An excessive cardiovascular response to acute stress is a probable risk factor for cardiovascular (CV) disease. Such reactivity is usually assessed from the CV response to laboratory stressors. However, if it is a risk factor, correlated responses must occur in real life.

DESIGN

In the present study, we investigated the relationship between the heart rate (HR) response to five laboratory stressors and HR reactivity in the field.

MEASURES

HR variation, the response to a real life stressor (public speaking), and the increase in HR with periods of self-reported tense arousal. Ambulatory HR, activity and posture were measured continuously over a 7-hr period.

RESULTS

The HR increase to laboratory stressors did not relate to HR variation consistently, but it did relate to the other two field measures.

CONCLUSION

The results suggested that a tendency to increased HR reactivity may be a risk factor for cardiovascular disease when combined with exposure to stress.

Age and gender differences in social anxiety symptoms during adolescence: the Social Phobia Inventory (SPIN) as a measure

The aim of the present study was to examine age and gender differences in social anxiety symptoms during adolescence, and to investigate the psychometrics of the Social Phobia Inventory (SPIN) among adolescents. The SPIN was administered to a large general population sample (n=5252) of Finnish adolescents aged 12-16 years. Age and gender trends in scores and internal consistency and factorial composition of the SPIN were examined in this sample. The test-retest reliability of the SPIN was examined in a smaller sample of adolescents (n=802). Results showed that girls scored higher than boys on the SPIN full scale and three subscales across the whole age range. Eighth graders (14- to 15-year-olds) scored higher than seventh and ninth graders on the full scale, for boys the differences were significant. Good test-retest reliability (r=0.81), and internal consistency (alpha=0.89) were found for the SPIN. An exploratory factor analysis (EFA) performed on a random half (n=2625) of the population sample yielded a one-factor model accounting for 38% of the variance between items. This one-factor model, plus an alternative three-factor model, were examined in the holdout half of the population sample (n=2627) by means of a confirmatory factor analysis (CFA). Some support was gained for both factor structures. Our results indicate that symptoms of social phobia may increase in mid-adolescence. The SPIN appears to be a reliable self-report instrument among adolescents.

The influence of hemodynamic factors on left ventricular mass

We evaluated the relationship between the variability in the left ventricular mass index (LVMI) and different hemodynamic factors. LVMI was associated with blood pressure and, in one subgroup, strongly to arterial pulse wave velocity (PWV). High physical activity was connected to increased LVMI, and a combination of low stroke index (SI) and high heart rate (HR) to decreased LVMI.

Determination of retinal blood vessel diameters and arteriovenous ratios in systemic hypertension: comparison of different calculation formulae

BACKGROUND

Generalized arteriolar narrowing is one of the retinal changes influenced by systemic hypertension. The ratio of retinal arteriolar to venular diameters is often used as a marker of generalized arteriolar narrowing. There are several ways to determine the retinal arteriovenous ratio (A/V ratio). However, no comparison of retinal vascular measurements and A/V ratios determined by different formulae has been presented.

METHODS

Eighty-seven men participating in the Tampere Ambulatory Hypertension Study returned for a 10-year follow-up examination in which fundus photographs were taken of both eyes. The diameters of retinal arterioles and venules were measured 1 and 2 disc diameters from the optic disc edge. The A/V ratio was determined using mean arteriole and venule width, the sum of widths of arterioles and venules, the sum of squares of widths of arterioles and venules, the central retinal artery equivalent (CRAE) and the central retinal venous equivalent (CRVE). The repeatability of measurements and A/V ratios was determined. Comparison was made between A/V ratios determined by different calculation formulas.

RESULTS

In general, determination of A/V ratios yielded lower deviation than that of diameters of arterioles and venules separately. Calculation of A/V ratios using different formulas gave different ratio levels. According to linear regression analysis, the A/V ratio calculated using the sum of squares of widths of arterioles and venules correlated best with CRAE/CRVE (R(2) 0.92) and A/V ratios calculated using the mean arteriole and venule widths or the sum of widths of arterioles and venules resulted in clearly lower associations (R(2) 0.38-0.40 and R(2) 0.41-0.48, respectively). Of all A/V ratios, CRAE/CRVE had the best repeatability. No statistically significant differences were found between measurements from right and left eyes.

CONCLUSIONS

The high repeatability of CRAE/CRVE and sum of squares of widths of arterioles/sum of squares of widths of venules, as well as the good association of the two formulae, favor the use of these in evaluation of retinal vascular changes in systemic diseases. Our results also showed that if only one eye can be examined, it seems to suffice if fundus vascular alterations associated with systemic hypertension are evaluated.

Diurnal and weekly rhythms of health-related variables in home recordings for two months

Several telecare systems for long-term monitoring of the well-being of patients at home have been developed as an aid in healthcare and to reduce hospitalization costs. Most of the systems have been designed to measure only one or two variables. Because well-being is a combination of both psychological and physiological wellness, there is a need to monitor several psychophysiological variables simultaneously in out-of-hospital conditions for a long period. To understand better the variability of patients' wellness-related variables in long-term recordings, the knowledge of the normal variation in health-related variables in healthy people is necessary. In our study, 14 healthy working middle-aged men were studied daily for 24 h and periods of 50 to 79 days. The variables measured were beat-to-beat heart rate, motor activity, blood pressure, body weight, and temperature. At night respiratory frequency, time of movements, amount of quiet sleep, and ballistocardiographic respiratory variation were also measured. Heart rate variability in the waking period was calculated later (standard deviation of the 5 min average of the successive normal to normal beat to beat intervals). Daily self-reported well-being, activities, and consumption of alcohol were monitored by keeping a behavioral diary. After normalizing the physiological data, the diurnal and weekly variability was calculated for each variable. In several variables the most notable diurnal and weekly variability was found between working time and free time. In conclusion, diurnal and weekly rhythms in several wellness-related physiological and psychological variables were identified, depending on working and free-time in healthy middle-aged men.

Psychological Stress Tasks in the Prediction of Blood Pressure Level and Need for Antihypertensive Medication: 9-12 Years of Follow-Up

Increased blood pressure (BP) reactivity to subtypes of psychological stimuli may differentially predict the development of future BP elevation or hypertension. The authors present the 9-12-year follow-up results of 82 (86%) of 95 male participants with different BP levels. They were healthy, untreated, and age-matched volunteers from a routine health checkup carried out on all 35-, 40-, and 45-year-olds from a medium-sized city. Intra-arterial systolic blood pressure (SBP) during the psychological tasks improved the prediction of future casual SBP and noninvasive 24-hr ambulatory SBP compared with predictions from casual diagnostic measurements. Diastolic blood pressure (DBP) was very useful when added to casual DBP in predicting the need for antihypertensive medication. Reactivity to active tasks especially predicts the need for antihypertensive medication.

Pulse pressure responses to psychological tasks improve the prediction of left ventricular mass: 10 years of follow-up

OBJECTIVES

To examine the role of casual blood pressure measurements and blood pressure responses to psychological tasks in the prediction of future left ventricular mass index (LVMI), and to determine the importance of different components of blood pressure, and the predictive value of an individual's personal characteristics and antihypertensive medication on future LVMI.

METHODS

At baseline, blood pressure was recorded by casual measurements; during tests it was recorded by intra-arterial monitoring. The participants were healthy, untreated 35-45-year old men. Echocardiography data both at baseline and after 10 years of follow-up were available from 65 individuals, of whom 49 (75%) were not taking antihypertensive medication at follow-up. Those not taking antihypertensive medication were included in the prediction of LVMI (g/m2).

RESULTS

Baseline LVMI correlated significantly with future LVMI only among the 49 unmedicated individuals (r = 0.52, P < 0.0001). The predictive value of baseline LVMI on future LVMI among them (adjusted coefficient of determination = 0.26) was not improved by the inclusion of casual blood pressure. In contrast, blood pressure responses to the psychological tasks improved the prediction of future LVMI by 4-13%. Pulse pressure was the blood pressure variable that entered the final prediction models; the correlations with future LVMI were best for pulse pressure response to habituation task (r = 0.43, P < 0.05) and to relaxation (r = 0.37, P < 0.05).

CONCLUSIONS

To our knowledge, this is the longest prospective follow-up to show that blood pressure responses to psychological tasks improve the prediction of LVMI compared with casual blood pressure measurements. The pulse pressure, which reflects the properties of the arterial wall, is the most significant blood pressure variable in predicting future LVMI.

Pulse pressure in tests improves the prediction of left ventricular mass: 10 years of follow-up

Literature does not agree with the usefulness of exercise blood pressure (BP) in predicting hypertension or target organ damage. In this prospective 10 years of follow-up, we evaluated if exaggerated BP responses to tests may improve the prediction of left ventricular mass index (LVMI). At baseline, BP was recorded by casual measurements, and during tests using intra-arterial monitoring. The subjects were 97 healthy, untreated 35- to 45-year-old-men (34 normotensive, 29 borderline hypertensive, and 34 mild hypertensive). At 10-year follow-up, echocardiography was performed to 86 (89%) of them. Subjects not taking antihypertensive medication (n = 66) were included in the prediction of LVMI(g m-2). Echocardiography data at baseline was available from 70 (72%) of the subjects, of whom 52 did not use antihypertensive medication at follow-up. Pulse pressure (PP) at supine test (r = 0.337, P = 0.006), PP at dynamic exercise last work load (r = 0.332, P = 0.006), and PP after dynamic exercise (r = 0.316, P = 0.010) were the best BP variables achieved in tests in predicting future LVMI of the 66 subjects. Casual BP did not significantly correlate with future LVMI. The best model in predicting LVMI included PP achieved after dynamic exercise, family history of hypertension, and body mass index (BMI) (adj.R2 = 0.207). Baseline LVMI correlated significantly with future LVMI only among the 52 unmedicated subjects (r = 0.508, P<0.0001). The predictive value of baseline LVMI on future LVMI among them (adj.R2 = 0.243) was best improved by PP achieved in supine test and age (adj.R2 = 0.350). In conclusion, BP measurements during tests improved the prediction of LVMI compared with casual BP. For the first time, the pulsatile component of BP in tests was found to be the most significant BP parameter in predicting future LVMI.

Can blood pressure responses to tests unmask future blood pressure trends and the need for antihypertensive medication? Ten years of follow-up

An exaggerated blood pressure (BP) response to test may unmask the subjects who have a high risk of developing hypertension. In this prospective 10 years of follow-up, we examined whether the predictive value of casual BP measurements on future BP level and need for antihypertensive medication could be improved by using BP responses to different physical tests. At baseline, BP was recorded by casual measurements and intra-arterial monitoring. During the intra-arterial BP recording, standardized postural and exercise tests were performed on 97 healthy, untreated men (34 normotensive, 29 borderline hypertensive, and 34 mild hypertensive). After 10 years of follow-up, 87 of them (90%) returned for casual and non-invasive 24-h BP measurements. At follow-up, 20 (23%) of the men had antihypertensive medication. The prediction of casual systolic blood pressure (SBP) was best improved by SBP at 10 min after the dynamic exercise test (adj. R2 = 0.448; adj. R2 = 0.356 for casual SBP alone). The prediction of casual diastolic blood pressure (DBP) was most improved by DBP at 10 min after the dynamic exercise test (adj. R2 = 0.282; adj. R = 0.259 for casual BP alone). SBP in the supine test best improved the prediction of 24-h SBP (adj. R2 = 0 448; adj. R2 = 0.275 for casual SBP alone). DBP in the standing test best improved the prediction of 24-h DBP (adj. R2 = 0.252; adj. R2 = 0.214 for casual DBP alone). Pre-exercise DBP and casual SBP were the best predictors of the need for antihypertensive medication (Cox-Snell R2 = 0.256; Cox-Snell R2 = 0.164 for casual SBP alone). In conclusion the prediction of future BP and need for antihypertensive medication can be improved by using BP measurements during postural and exercise tests. Future SBP is more predictable than DBP.

Pulse pressure is the best predictor of future left ventricular mass and change in left ventricular mass: 10 years of follow-up

BACKGROUND

Ambulatory blood pressure correlates more closely with left ventricular mass (LVM) than casual blood pressure in cross-sectional studies, but prospective evidence is very limited.

OBJECTIVE

To evaluate the best predictors of LVM and change in LVM during 10 years of follow-up, in a prospective study.

METHODS

At baseline, blood pressure was recorded by casual measurements and 24 h intra-arterial ambulatory monitoring. The study participants were 97 healthy, untreated, 35-45-year-old men (34 normotensive, 29 borderline hypertensive, and 34 mildly hypertensive). At 10-year follow-up, echocardiography was performed in 86 (89%) of the men; echocardiographic data were available both at baseline and at follow-up from 70 (72%) of them. Individuals who were not receiving antihypertensive medication (n = 66) were included in the prediction of LVM index (LVMI), which was analysed as a continuous variable.

RESULTS

The blood pressure variables that were best in predicting the LVMI were: 24 h pulse pressure (r = 0.308, P = 0.012), night-time pulse pressure (r = 0.291, P = 0.018), daytime pulse pressure (r = 0.253, P = 0.041), and casual systolic blood pressure (r = 0.212, P = 0.088). The LVMI was best predicted by a model including 24 h pulse pressure, positive family history of hypertension, body mass index, and age (adjusted coefficients of determination (adj.R2) = 0.197; that for the casual blood pressure model was adj.R2 = 0.140). During the follow-up, LVMI increased by +7.5 g/m2 and +23 g/m2 in individuals receiving and not receiving antihypertensive medication, respectively (P = 0.015). The change in LVMI was best predicted by the change in casual pulse pressure and use of antihypertensive medication (adj.R2 = 0.102).

CONCLUSIONS

Ambulatory blood pressure improved the prediction of future LVMI compared with that obtained from casual measurements. To our knowledge, this is the longest prospective follow-up to show that pulse pressure is the most significant blood pressure parameter in predicting future LVMI and change in LVMI.

Prediction of blood pressure level and need for antihypertensive medication: 10 years of follow-up

OBJECTIVE

To evaluate the usefulness of blood pressure and its variability in the prediction of future blood pressure and need for antihypertensive medication.

METHODS

We used WHO criteria to classify, at baseline, 97 healthy untreated male volunteers as normotensive (n = 34), borderline hypertensive (n = 29) or mild hypertensive (n = 34), with casual measurements before intra-arterial 24 h ambulatory blood pressure monitoring. After 10 years of follow-up, 87 of the men (90%) were available and their blood pressure was recorded using casual measurements and non-invasive ambulatory 24 h monitoring.

RESULTS

During the follow-up, the blood pressure classification deteriorated in 35 individuals (40%) and improved in six (7%) (McNemar test, P< 0.0001). In the borderline hypertensive group, 77% became hypertensive (P= 0.03). The 24 h mean systolic blood pressure was the best predictor of follow-up casual systolic (adj.R2 = 0.420) and 24 h systolic (adj.R2 = 0.540) blood pressure. The 24 h mean diastolic blood pressure was the best predictor of follow-up casual diastolic (adj.R2 = 0.301) and 24 h diastolic (adj.R2 = 0.292) blood pressure. The baseline casual systolic blood pressure also predicted the follow-up casual systolic blood pressure relatively well (adj.R2 = 0.356), but was clearly weaker for the follow-up 24 h systolic (adj.R2 = 0.275) blood pressure. The prediction of follow-up casual diastolic (adj.R2 = 0.259) and follow-up 24 h diastolic (adj.R2 = 0.214) blood pressure by baseline casual blood pressure was even weaker. The means and variabilities of the 24 h, daytime, and night-time blood pressures were the best predictors of the need for antihypertensive medication (Cox-Snell R2 = 0.399). The characteristics of the individual did not significantly predict future blood pressure and the need for antihypertensive medication.

CONCLUSIONS

The 24 h mean blood pressure was an excellent predictor of the future blood pressure and the need for antihypertensive medication. Prediction of antihypertensive medication was further improved by also using blood pressure variability. Systolic blood pressure was more predictable than diastolic blood pressure.

Recent body-weight changes and weight loss practices in the European Union

OBJECTIVES

The aim of this paper is to describe recent weight changes and weight loss practices in the EU, and in particular to describe the group of subjects who were in a recent state of weight gain.

DESIGN AND SUBJECTS

Overall, 15,239 adults aged 15 years and upwards composed of 1000 from each EU member state were selected to complete the interview-assisted face-to-face questionnaire. In each member state, sample selection was quota-controlled to ensure national representativeness.

RESULTS

This survey points to a fairly alarming tendency of more normal weight, overweight or obese European people being in a state of weight gain rather than weight loss. But it is also worrying that almost a fifth of underweight people are in the process of losing more weight. The recommendations for interventions to promote weight loss might be somewhat different between countries in the EU as the common weight loss practices differ between such countries. Overall, a campaign alone may not be effective in encouraging people to do more physical activity in Europe. Additional methods should be found. Furthermore, a combination of diet and exercise as a method of weight control is underestimated or undervalued by the general population who are either overweight or obese.

Psychological and physiological characteristics of sweet food "addiction"

OBJECTIVE

Drug addicts in general can be distinguished from nonaddicts by their affective and physiological and craving responses to drug-related cues. The purpose of this study was to examine similar affective, physiological, and behavioral variables in chocolate "addicts" and control subjects.

METHODS

Sixteen addicts and 15 control subjects took part in two laboratory experiments in which their heart rate, salivation, and self-reported responses were measured.

RESULTS

In the presence of external chocolate cues, chocolate addicts were more aroused, reported greater cravings, experienced more negative affect, and also ate more chocolate than control subjects. Self-report measures on eating attitudes and behavior, body image, and depression confirmed that a relationship exists between "chocolate addiction" and problem eating. Chocolate addicts showed more aberrant eating behaviors and attitudes than controls, and were also significantly more depressed.

DISCUSSION

Chocolate addicts may be considered to be a parallel with addicts generally, because they differ from controls in craving for chocolate, eating behavior, and psychopathology (in respect of eating and affect).

Reasons for initiation and cessation of eating in obese men and women and the affective consequences of eating in everyday situations

Reasons for the initiation and termination of eating were investigated in 78 female and 36 male obese subjects following a weight control programme. Self-monitoring diaries were completed during a 24-h period, in which subjects selected the main reason for starting and stopping an eating episode. Additionally, subjects recorded mood before and after eating using visual analogue scales. Hunger was chosen as a reason to start eating in only 20% of cases. Environmental cues such as mealtime were selected as the main reason for the initiation of the majority of eating episodes. In contrast, self-assessments such as "I felt I had eaten enough" was the main reason for terminating eating (39.4%). Gender differences in the reasons for initiating eating revealed a greater tendency for men to initiate eating for environmental reasons than women, whereas the opposite was found for the termination of eating, with women more likely to stop eating for environmental reasons than men. Changes in affect during eating revealed a significant decline in negative emotions such as tension and tiredness, and in the heavier subjects a trend for increased happiness was observed following eating. As hunger was less commonly reported as a reason to start eating than external reasons, treatment strategies for the obese might benefit by targeting individual reasons for meal initiation.

Intra-arterial blood pressure and heart rate reactivity to behavioral stress in normotensive, borderline, and mild hypertensive men

Intra-arterial blood pressure (BP) stress reactivity was studied in newly detected, World Health Organization-classified (1978), age-matched normotensive (NT; n = 33), borderline hypertensive (BHT; n = 30), and hypertensive (HT; n = 32) men recruited through routine health examinations. They underwent a relaxation baseline followed by 8 standardized behavioral challenges. BHT and HT men displayed exaggerated BP reactivity compared with NT men, particularly on perceptual-motor and social tasks, and HT men showed higher reactivity than NT men in the cold pressor test. These results are the first to show reactivity differences between NT men and BHT or HT men in an intra-arterial experiment. Diastolic BP (DBP) discriminated the groups better than systolic BP (SBP) or heart rate (HR). The few differences in SBP compared with DBP among the groups combined with hardly any differences in HR indicate the predominance of vascular factors in middle-aged as opposed to younger men with borderline or mild hypertension.

Intra-arterial blood pressure and heart rate reactivity to behavioral stress in normotensive, borderline, and mild hypertensive men

Intra-arterial blood pressure (BP) stress reactivity was studied in newly detected, World Health Organization-classified (1978), age-matched normotensive (NT; n = 33), borderline hypertensive (BHT; n = 30), and hypertensive (HT; n = 32) men recruited through routine health examinations. They underwent a relaxation baseline followed by 8 standardized behavioral challenges. BHT and HT men displayed exaggerated BP reactivity compared with NT men, particularly on perceptual-motor and social tasks, and HT men showed higher reactivity than NT men in the cold pressor test. These results are the first to show reactivity differences between NT men and BHT or HT men in an intra-arterial experiment. Diastolic BP (DBP) discriminated the groups better than systolic BP (SBP) or heart rate (HR). The few differences in SBP compared with DBP among the groups combined with hardly any differences in HR indicate the predominance of vascular factors in middle-aged as opposed to younger men with borderline or mild hypertension.

Blood pressure level and variability in the prediction of blood pressure after 5-year follow-up

We compared mean intra-arterial ambulatory blood pressure (IAMB), blood pressure (BP) diurnal profiles are variability, and postural measurements with casual sphygmomanometric measurements for the prediction of future BP. We studied 97 healthy, ummedicated men classified as normotensive (NT, n = 34), borderline hypertensive (BHT, n = 29), or mildly hypertensive (HT, n = 34) by repeated casual measurements during the 2 months before IAMB. Five years later, we reassessed 79 subjects (81%) using casual BP measurements and noninvasive ambulatory 24-hour BP monitoring (NAMB). IAMB level generally correlated well with follow-up BP and slightly better with NAMB level than with casual measurements (24-hour IAMB versus follow-up NAMB systolic BP [SBP], r = .64, P < .001; versus diastolic' BP [DBP], r = .52, P < .001). NT and BHT subgroup correlations were of similar strength, but the relationship in the HT subgroup was not significant. Similarly, when we examined daytime and nighttime BP levels, nighttime BP correlated better with follow-up BP in NT and BHT but not in HT. The only measures that were significantly related to follow-up BP in HT were two BP variability measures, SD and the range of variability (RV80: 90th minus 10th percentile), (initial 24-hour IAMB SD and follow-up BP, r = .42 to r = .52, P < .05 to P < .01; RV80 versus follow-up BP, r = .43 to r = .52, P < .05 to P < .01). Correlations of follow-up BP with postural BP were generally weaker than with casual BP or IAMB level. Linear stepwise regressions for SBP and DBP separately (including all IAMB variables) demonstrated that the best single predictor for follow-up BP was 24-hour IAMB SBP level, which explained 41% of follow-up NAMB SBP level variance (F = 52.6, P < .001). However, in a second analysis including casual values, casual SBP alone explained 44% of follow-up NAMB SBP variance (F = 62.5, P < .001), whereas IAMB SBP added only 4% (F = 5.5, P < .05). Predictions of follow-up DBP were always poorer. After 5 years, 70% of NT and 86% of HT were still in their initial classification group, but 67% of BHT had become hypertensive. In these new HT (n = 16), initial IAMB level correlated most strongly with follow-up NAMB level (24-hour SBP, r = .70, P < .01; 24-hour DBP, r = .55, P < .05). The only other significant demographic variable predicting future BP was change in weight over 5 years, which added 10% to the explanation of future casual SBP variance (F = 12.5, P = .0007) and 15% to casual DBP variance (F = 18.0, P = .0001); for NAMB, the percentages were lower. In logistic regression, those NT and BHT who became hypertensive (n = 22) had a 75% probability of becoming hypertensive if they gained 11.7 kg or more during 5 years (X2 = 4.5, P = .03). To conclude, BP tended to increase in all groups, especially in BHT, during follow-up. Nominal differences were observed between casual measurements and BP level measures in the prediction of future BP, and their explanatory value for future BP was generally less than 50%. However, for BHT who became hypertensive, BP level and variability measurements somewhat improved the prediction of follow-up BP. Weight gain was an important additional predictor for future hypertension in both NT and BHT.

The ambulatory measurement of posture, thigh acceleration, and muscle tension and their relationship to heart rate

We compared the relative ability of continuous accelerometric, electromyographic (EMG), and hydrostatic posture measurements to discriminate tasks involving variations in motor activity and posture and to predict heart rate (HR) variability. EMG was a more sensitive measure than accelerometry in differentiating the tasks. However, accelerometry and EMG explained comparable amounts of HR variance. The hydrostatic posture was a stable measure that clearly differentiated postures and explained a significant amount of HR variance but less than accelerometry or EMG. Accelerometric and EMG measures of motor activity used either alone or in combination with the hydrostatic posture are valuable in discriminating activities and in controlling for the effects of motor activity and posture on HR during ambulatory measurement.